When Dr. Luis Pacheco throws a health fair in East L.A., people come. Mainly it's women, but the men come too, joining a long line to see the good doctor. When they finally get their face time, the news is usually bad. The majority are overweight and bordering on diabetic, if they aren't already. For those who lack health insurance (most), it's their only chance to see a physician. Plus, everyone knows Dr. P. is the best.

With his Latin good looks and trim physique, Luis Pacheco is somewhat of a celebrity doctor in the Hispanic community; although for a University of Southern California-trained MD, dedicating his work to serve the underserved, perhaps hero would be a more apt term.

When he's not seeing patients, Pacheco is busy sounding the alarm. The emergency is a health crisis in the Hispanic community-"a tidal wave that's coming," he says.

A Booming Problem

There are 50 million Hispanics in the United States. That's more people than live in Canada. It's more than the population of Spain. And it's a very fast growing population that is expected to triple by 2050. Sadly, it's a very unhealthy population too, notes Pacheco. "You have a lot of people making bad lifestyle choices-eating very poorly, not getting enough exercise."

The impact of an unhealthy population of this size will be disastrous, predicts Pacheco. "We are going to have out-of-control healthcare costs that will be astronomical. I think most people have no idea how incredibly expensive it will be to care for this population."

The picture of failing health that Pacheco paints is bleak. "When you are obese, you are prediabetic or diabetic until proven otherwise. So with the obesity epidemic we have the diabesity problem, and now we are seeing it in adolescents. Instead of patients being diagnosed in their late 40s and 50s, now they are diagnosed at 14 and 15.

"Imagine an enormous population of 30- to 40-year-olds with major medical problems due to uncontrolled diabetes and obesity, like blindness, amputations, foot ulcers, dialysis, renal failure, and then of course heart disease and strokes. This is going to be a serious problem because these will be 30-year-olds instead of 70- and 80-year-olds. So unless we do something about it, there will be a lot of people with long-term chronic illness for 20 to 30 years.

"Not to mention a tremendous cost in terms of quality of life for these people," Pacheco continues. "It will be hard for them to enter the workforce, hard for them to provide for their families, and hard for them to enjoy their lives; and then the financial impact could really cripple economies on a global scale."

Beyond Tortillas and Lard

What makes the Hispanic community so vulnerable to obesity? It's part genetics and part environment, Pacheco explains. "Unfortunately for many Hispanics, a chubby baby is regarded as a healthy baby. Well, we know now that a chubby baby predisposes it to diabetes later in life," he says.

Low awareness of nutrition presides among Hispanics, and when there is awareness, motivation is often lacking. "The sad reality is that many people, Hispanics and non-Hispanics alike, are probably more aware of what the specials are at the big fast-food chains than they are of healthy eating," Pacheco remarks.

Rampant unemployment also drives poor nutrition. "We know that if you lack financial health, your chances of having poor physical and emotional health are much higher. These are hard-working people, but if they don't have jobs, then it's a downward spiral: What's the cheapest way to feed yourself? Fast food. So you start taking the easy way out."

The spiral goes something like this, according to Pacheco: Frustrations come from lack of employment, which means lack of financial stability and access to healthy foods and
health insurance, followed by lack of culturally relevant healthy and affordable products that
are designed for the Hispanic and Spanish-speaking community.

Add to this a growing characteristic in the community that Pacheco finds very troubling: the "victim mentality." "I'm hearing more of 'It's someone else's fault that I'm obese.' Of course there are a number of reasons for someone to be obese, but I think that once we start becoming victims, we give up. And then the problem is only going to get worse. So one of the messages that I am trying to get out there is that we need to be strong and determined, not be victims."

A Financial Issue

With their $1 trillion in spending power, why are manufacturers reluctant to market healthy products to the Hispanic community? "It's a financial issue," Pacheco says. "If you are a huge corporation, why should you spend a lot of time on 15-20 percent of the population? It's the old 80/20 rule-you should be spending your company's time and resources on the 80 percent and not worry too much about the
20 percent.

"But we know now that the 15-20 percent is growing and beginning to have significant spending power, and people are starting to take notice. In the past, there was a belief that a lot of Hispanics were poor and couldn't afford to buy these products. But now the numbers don't lie. Another big challenge is that companies don't know where to start or even what products to introduce. I've seen some attempts, but
more effort must be put forward so that the products really resonate. It's a lot of work; it can be challenging; and therefore, for many companies, it's easier to go after the rest of the market instead."

Pacheco makes sure his speaking schedule includes business venues where he can reach natural products manufacturers, marketers and investors and explain that there's money to be made in the Hispanic community while providing healthier food and supplement options.

"The natural products industry is the perfect area for products that serve the Hispanic population," Pacheco told a packed room of the leading natural food and supplement manufacturers at last year's Nutrition Business Journal Summit in California. "Hispanics
believe in botanicals and are wary of drugs
and the potential side effects," he informed
the audience.

More of a Doer

Immersed daily in this challenging environment, how does Pacheco stay motivated? "I've never really thought about it; it's never really been a consideration." A rather surprising response from a man who hadn't planned on working in underserved populations until his residency.

Pacheco was raised on the Upper West Side of New York City by a mother who had departed her native Peru to study on a scholarship at Columbia. His father left when Pacheco was six months old.

"My mother always stressed education; always said stand up straight and be proud of who you are, you can do whatever you want to do-all those clichés, most of which we know are true if you follow through on them."

There was never any question that he would be a doctor. "I was groomed to be a doctor. There are baby pictures of me with the kids' doctor's kit and stethoscope."

During childhood, Pacheco spoke mostly Spanish at home. "I lived in Peru for a few years as a child. That was a great experience. I've had exposure to many different Hispanic cultures. Growing up on the East Coast, I spent a lot of time with Puerto Ricans and Dominicans." He also had the opportunity to learn about European culture, having studied in France for a year as a teenager.

Pacheco's exposure to Latin communities served him well when doing his residency at USC in Los Angeles, where a seed was planted that would shape his career. "In my residency training we took care of a large number of underserved areas of Latinos and African Americans. I got a very close look at what was destroying those communities."

Pacheco knew then that he wanted to help underserved populations-but through doctoring, not sitting in meetings. "I was never really politically active in college or residency. I always thought that my time was better spent doing something, rather than sitting in a bunch of meetings merely talking about problems instead of focusing on solutions. I know some organizations do a great job, but I am more of a doer than just a talker."

Plan of Action

Hundreds of health fairs and Spanish-language radio and television shows later, Pacheco is involved in plenty of doing. Although he's often the bearer of bad health news, his diagnosis is always tempered with practical advice. "I tell patients that they don't have to go on a fancy diet, and I give them practical tips instead: 'Do you drink a lot of soda? Oh, you do. Well, simply cut out one soda per day and you will lose 10 pounds in a year without dieting. You like tortillas? Eat one less tortilla a day and you just lost another 10 pounds.'"

Currently Pacheco is gathering resources and support for a Spanish-language TV show that would be a combination of the Dr. Phil, Dr. Oz and Dr. Drew shows, seasoned with a Hispanic flavor. "From going to the health fairs I know that the need and desire for more information is there, but Hispanics don't have anywhere or anyone to turn to. It would be a whole new concept to do a wellness show in Spanish. We want it to be educational and entertaining, with a goal of making people feel good about wellness and inspired to get more involved in their lifestyle choices."

Pacheco's vision to turn around the Hispanic community's health crisis goes beyond health fairs and television, however. "Someone approached me recently and said I should be the Surgeon General, and I thought, 'You're right, I should.'"

Whether it's the result of his direction from a Washington office or not, Pacheco would like to see a more concerted government effort to help minorities embrace wellness.

"It's not that the government isn't spending hundreds of millions of dollars, but where is that money going? There are no concerted programs making a real difference in the Hispanic situation," he says.

The first step in reversing the obesity trend is with the kids, according to Pacheco. "We are educating adults, hoping they will change their behavior; it's going to be hard and take a long time. The kids we can reach right away."

An excellent place to reach children is at school, including preschool, Pacheco advises. "Obesity and wellness campaigns have to start with the very young and via programs in schools that kids can relate to. We have classes in history and math, but we don't have classes in lifestyle. What happened to home economics classes? Let's bring them back and teach kids how to cook, eat and live in a healthy way; this is fundamental stuff."

These classes could result in children bringing home the wellness message, he says. "If the kids are saying, 'Mom, use olive oil instead of lard,' then the parents get the message peripherally."

And get those kids in physical education five days a week, Pacheco asserts. "Don't tell me you don't have teachers or facilities; you throw a stick or a ball out there and kids will figure out ways to play. When you see schools cutting back PE classes, it makes no sense at all; it makes me insane."

Another area he believes holds potential to change bad health habits is prenatal care. "My experience over the past 20 years is that the vast majority of pregnant women I've seen will do almost anything to take care of themselves to have a healthier baby. But after the baby is born, it's back to the old habits. So I think that prenatal period is an extremely powerful opportunity to intervene and educate and inform them."

Determined Optimist

To help bring about awareness and alter the path of the coming Hispanic health-crisis tidal wave, Pacheco urges individuals and companies to become as well informed as possible about the Hispanic culture and to be active on school boards, doing things like demanding PE five days a week, and also to contact politicians. "Even if your family isn't affected by obesity, it's everyone's problem," he says.

In the face of alarming statistics and daily face time with a community on the brink of health collapse, Pacheco is undaunted. "I don't feel any frustration; we can overcome this situation. It's not going to happen overnight-it will take a generation-but we can do it. I guess I'm that kind of person: the glass is always half full. I just never give up; it's very straightforward with me. Churchill said it best: 'Never, ever, ever, ever, give up.'"

For further information on preventing obesity among Latino children, visit www.salud-america.org; and for more on the childhood obesity epidemic, see www.reversechildhoodobesity.org.